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Introduction: Severe hypertension in pregnancy deserves prompt recognition and urgent effective reduction in order to reduce the risk of complications such as eclampsia and HELLP syndrome and to achieve desirable neonatal outcomes. There is a need for effective and safe parenteral antihypertensive treatment. Subjects and Methods: We studied the effectiveness and safety of intravenous labetalol use in severe hypertension in pregnancy and post-partum period in a teaching hospital in Chhattisgarh in 101 women. IV labetalol was given as bolus doses till the blood pressures were controlled. Neonatal outcomes were recorded, and adverse effects such as hypotension, hypoglycemia, and neonatal asphyxia were documented. Results: Intravenous labetalol given as a single bolus of 20 mg was efficacious in controlling blood pressures in 93 out of 101 (93%) women, and the rest were controlled with 1 or 2 additional doses in 1–3 hours. No neonatal deaths happened beyond the 13 intrauterine fetal deaths at presentation. No women developed any episodes of hypotension, tachycardia of more than 100, or nausea or vomiting on labetalol. Conclusion: Intravenous labetalol, even as a single bolus dose, is highly efficacious and is free of any major adverse effects.

Background Objectives Search Strategy Results Conclusion Shoulder dystocia is an unpredictable obstetric condition with potential long‐term neonatal complications. The risk of neonatal injury might be related to the condition itself as well as to the obstetrics maneuvers used for its release.To examine the available evidence to assess current management and possible improvement of outcomes.A comprehensive search of MEDLINE, EMBASE, EMCARE, and The Cochrane Library database was performed, all studies reporting on neonatal outcomes in cases of shoulder dystocia stratified by obstetric maneuvers used for delivery were included. Data abstraction was performed and checked by two independent reviewers.McRoberts maneuver was the least associated with risk of neonatal injury (odds ratio 0.6, 95% confidence interval 0.4–0.9), followed by delivery of posterior arm.Delivery of posterior arm might be prioritized in cases of shoulder dystocia after failed McRoberts. Neonatal hypoxic injury correlates with the duration of dystocia rather than the maneuver used. [ABSTRACT FROM AUTHOR]

Introduction: Ectopic pregnancy occurs when implantation of a blastocyst takes place in a site other than the endometrium of the uterine cavity. Cesarean scar (CS) site ectopic has an incidence of 1 in 1,800, which occurs when a blastocyst implants in the anterior lower uterine segment at the site of the CS. Here we report a series of four rare cases of low-lying implantation ectopic pregnancy (LLIEP) and different treatment modalities performed in such scenarios. Case 1: A 28-year-old P2L2A1 presented to the emergency obstetrical unit with complaints of bleeding per vagina for 15 days. She provided a history of medical termination of pregnancy (MTP) pill intake at 1 month of gestation, followed by bleeding per vagina for 1 week. Dilatation and curettage were done on a private hospital patient, after which she continued to bleed for 10–12 days, associated with the passage of clots. Per abdomen examination, uterus was 12–14 weeks old, soft, non-tense, and non-tender. On p/s examination, 20-cc foul-smelling, blood-stained discharge was noted. The uterus was 12 weeks old, anteverted, tender, and mobile. A mass of 10 × 7 × 6 cm was felt in the anterior fornix, not separate from the uterus, extending into the right fornix. No fullness felt in the pouch of Douglas. Investigations: Hb-6.9 g/dL, Beta HCG-1250 IU/mL. A provisional diagnosis of septic incomplete abortion with severe anemia from two previous cesarean deliveries was made. Ultrasound revealed large vascular retained products of conceptions (RPOCs), but the exact location of RPOCs was not identified. Anterior myometrial wall thinning was noted. The patient was taken up for diagnostic laparoscopy with suction and evacuation under general anesthesia. On laparoscopy, dense adhesions are seen between the anterior abdominal walls, omentum, and anterior surface of the uterus until the fundus. The left side of the uterus could not be seen due to adhesions. Under vision suction, evacuation was started. There was torrential hemorrhage per vaginam. A decision for an emergency laparotomy was taken. A typical hourglass appearance of the uterus is noted. A small, non-pregnant firm fundus sits over the top of a large 10 × 8 × 7 cm lower uterine segment and a profusely thinned-out anterior wall. Myometrium was deficient on the anterior surface of the lower segment. Only the serosal layer was identified, through which products of conception were seen. A diagnosis of low-lying implantation of pregnancy was made. Cauliflower-shaped fungating growth was visualized after the serosal layer gave away. A lifesaving hysterectomy was done due to torrential bleeding. A cut section showed a non-pregnant fundus with a ballooned-out cervix. Histopathology confirmed the diagnosis of LIEEP. A total of six units of packed red cells and four frozen plasmas were transfused, and the patient was a maternal near-miss later discharged on day 7. Case 2: A 28-year-old G3P2L2 patient who had two previous lower segment cesarean section (LSCS) presented to us post-self-MTP pill intake with spotting pv at 9+5 weeks of gestation. Ultrasound revealed a type 1 CS ectopic pregnancy with a crown-rump length corresponding to 7+3 weeks and evidence of a fetal pole without cardiac activity in the lower uterine segment. β-hCG levels are 52,540 IU. Both medical and surgical options were explained to the patient, and she insisted on medical management. A multi-dose regimen of methotrexate was given, following which there was a significant fall in β-hCG levels. The patient came to the emergency room with torrential bleeding on day 19 in hypovolemic shock. Resuscitation and emergency lifesaving hysterectomy were done, and she was discharged on postoperative day 4. Case 3: A 37-year-old female G4P2L1A1 with 2 months of amenorrhea was referred in view of an ultrasound scan depicting pregnancy in the lower uterine segment with absent cardiac activity. Serum βhCG 6000 mIU/mL. Transvaginal sonography (TVS) depicted a gestational sac of diameter 12 mm in the lower uterine segment, eccentrically located in the anterior wall of the uterus, abutting the previous CS; the yolk sac and fetal pole were visualized; cardiac activity was absent; and a probable diagnosis of CS ectopic pregnancy was made. Medical management using a methotrexate regimen was chosen after informed consent, and 1 mg/kg (84 mg calculated dose) was administered intramuscularly on days 1, 3, 5, and 7 with folinic acid (0.1 mg/kg) on alternate days. Vital signs remained stable, and levels of βhCG declined. However, the patient’s successive ultrasounds revealed an increase in MSD from 1.2 cm on day 0 to 1.7 cm on day 10, with the gestational sac protruding toward the endometrial cavity. Suction evacuation was done under ultrasound sonography (USG) guidance. At follow-up, βHCG was 36.1 and 1.4 mIU/mL after 1 and 2 weeks, respectively. Case 4: A 33-year-old, G3P2L2 31 weeks, presented with a complaint of bleeding per vaginam and fever since one day. The patient did not perceive fetal movements throughout the pregnancy. Ultrasonography done 2 days back depicted an intrauterine death at 20 weeks gestation. On per abdomen examination the uterus was 20 weeks, non tense, non tender and with no fetal heart sound. os was closed, cervix posterior, and uneffaced. A bedside ultrasonography reconfirmed intrauterine death at 20 weeks gestation. The lower uterine segment was distended, with the fetus primarily in the lower uterine segment. Cervical ripening and induction were done with dinoprostone gel 0.5 mg eight hourly for three doses, to which there was no response. On repeat examination, the cervix was high up, 10–20% effaced, loose hanging, 3 cm dilated, and the presenting part felt with the tip of the finger, which was soft placenta. The patient was taken up for a Cesarean section. There was a typical hourglass appearance of the uterus; an empty upper segment of the uterus was sitting on top of an overly distended Couvelaire lower uterine segment. A dead fetus of 20 weeks gestation was lying transversely in the leaves of the left broad ligament, while a separated placenta was lying in the lower uterine segment. The tissues were foul-smelling. A peripartum hysterectomy with repair of a broad ligament hematoma was done. Massive blood transfusions and intensive care unit (ICU) for 24 hours were given. The patient was discharged on POD 11. Low-lying implantation of ectopic pregnancy is a life-threatening cause of maternal morbidity and mortality. Currently, there are increasing trends in the incidence of LLIEP due to clinical suspicion and better diagnostic modalities. TVS, Color Doppler, and magnetic resonance imaging (MRI) remain gold standard modalities for the early diagnosis of LLIEP. Failure or delay in diagnosing it will lead to catastrophic complications, which can cause obstetric emergencies. [ABSTRACT FROM AUTHOR]

Background: Pregnant women are a special population in which hospitalizations are more recommended due to physiological changes mimicking pathologies and medico-legal concerns. Objectives: We aimed to assess the obstetric outcomes of expectant mothers who were admitted to the obstetrics emergency outpatient clinic and declined the hospitalization advised by doctors. Additionally, we examined the appropriateness of physicians' recommendations. Design: We have retrospectively evaluated the patients admitted to the 'Obstetric Emergency Outpatient Clinic' and refused hospitalization between 1 January 2019 and 31 December 2019. Methods: Cases were classified into three groups based on the trimester, considering the substantial variation between complaints and complications in each trimester. The complaints of pregnant women were categorized as psychosocial causes, obstetric complications, maternal systemic complaints, and suspicion of labor. We evaluated the compatibility of the hospitalization decision with the pregnancy outcome of patients. Results: A total of 958 pregnant women were included in the study. Leading causes for admissions were obstetric complications, maternal systemic complaints, and suspicion of labor in first, second, and third trimesters, respectively. Psychosocial causes were mostly observed in the second trimester. Readmission to the hospital within a week was highest in the third trimester group. According to pregnancy outcomes, 12.5% (94/753) of our recommendations were appropriate in all trimesters. Conclusion: Obstetricians seem overcautious in managing obstetric patients and willing to offer hospitalization more often than the actual requirements. [ABSTRACT FROM AUTHOR]

Background: In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between 2017 and 2020 in a large maternity referral hospital in the country and identify their key determinants to inform future prevention efforts. Methods: This was a retrospective cross-sectional analysis with a nested case–control study of women giving birth at the National Maternal and Child Health Centre (NMCHC) in Phnom Penh, 2017–2020. We calculated percentages of singleton births at ≥ 22 weeks' gestation resulting in stillbirth and annual stillbirth rates by timing: intrapartum (fresh) or antepartum (macerated). Multivariable logistic regression was used to explore factors associated with stillbirth, where cases were all women who gave birth to a singleton stillborn baby in the 4-year period. One singleton live birth immediately following each case served as an unmatched control. Multiple imputation was used to handle missing data for gestational age. Results: Between 2017 and 2020, 3.2% of singleton births ended in stillbirth (938/29,742). The stillbirth rate increased from 24.8 per 1000 births in 2017 to 38.1 per 1000 births in 2020, largely due to an increase in intrapartum stillbirth rates which rose from 18.8 to 27.4 per 1000 births in the same period. The case–control study included 938 cases (stillbirth) and 938 controls (livebirths). Factors independently associated with stillbirth were maternal age ≥ 35 years compared to < 20 years (aOR: 1.82, 95%CI: 1.39, 2.38), extreme (aOR: 3.29, 95%CI: 2.37, 4.55) or moderate (aOR: 2.45, 95%CI: 1.74, 3.46) prematurity compared with full term, and small-for-gestational age (SGA) (aOR: 2.32, 1.71, 3.14) compared to average size-for-age. Breech/transverse births had nearly four times greater odds of stillbirth (aOR: 3.84, 95%CI: 2.78, 5.29), while caesarean section reduced the odds by half compared with vaginal birth (aOR: 0.50, 95%CI: 0.39, 0.64). A history of abnormal vaginal discharge increased odds of stillbirth (aOR: 1.42, 95%CI: 1.11, 1.81) as did a history of stillbirth (aOR: 3.08, 95%CI: 1.5, 6.5). Conclusions: Stillbirth prevention in this maternity referral hospital in Cambodia requires strengthening preterm birth detection and management of SGA, intrapartum care, monitoring women with stillbirth history, management of breech births, and further investigation of high-risk referral cases. Plain language summary: In Cambodia, there is very little information published on stillbirths to know precisely how many there are and to understand the underlying reasons they occur so they can be prevented in the future. Our study aimed to quantify the number of stillborn babies and identify some underlying risk factors from one of the largest maternity referral hospitals in Phnom Penh, Cambodia. We examined data from almost 30,000 health facility medical files of women who gave birth between 2017 and 2020 which included 938 stillbirths. We found that about 3.2% of births ended in a stillbirth and that this percentage increased between 2017 and 2020. Women who had preterm babies, or whose babies were small in weight for their gestational age, and babies that were born breech had a higher chance of being stillborn. Women who had abnormal vaginal discharge, which can indicate a possible infection, also had a higher odds of having a stillbirth. We also found that women who had a stillbirth previously had almost three times higher chance of having another stillborn baby. Having a caesarean section reduced the likelihood of having a stillborn baby by about half. These findings suggest that efforts are needed to better identify and manage women with preterm births and monitor fetal growth as well as ensure breech births are managed adequately. [ABSTRACT FROM AUTHOR]

Background: Ectopic pregnancy and its consequences are the most severe form of obstetric emergency during first trimester of pregnancy. It is a kind of life threatening emergency leading to significant maternal morbidity and even mortality. Methods: A prospective study was conducted at a tertiary care centre GGH Kadapa from 01 Jan 2022 to 31 Dec 2022. All cases of ectopic pregnancy which were admitted and managed during this study period were included in the study. All Collected data were analysed with epitable 6.04 version and SPSS version 20 Software. Results: During the study period total 34 cases of ectopic pregnancy were studied. Classical symptoms of amenorrhoea, pain abdomen and bleeding per vaginum were observed in 7 cases (20.5 %) whereas 25 cases (73.5%) were associated with pain abdomen only and 7 cases (20.5%) had the symptoms of bleeding per vaginum only. All cases were managed surgically. The incidence of ectopic pregnancy was one in 200 delivered pregnancy. Most were multiparas and common in 25-35 yr age group (73.5%). Tubal ectopic pregnancy was common in right side 22 cases (61%). Approximately 18 cases (52%) presented with haemoperitoneum and (56%) 17 cases required more than 2 pint blood transfusion. Conclusions: Ectopic pregnancy mostly presents as an obstetrics emergency in our hospital especially with rupture ectopic pregnancy with haemoperitoneum. Early diagnosis and intervention suited best for the situation is mainstay for favourable and successful outcome. [ABSTRACT FROM AUTHOR]

Uteroplacental apoplexy is a very rare pathology characterized by extravasation of blood in the myometrium secondary to a massive retroplacental hematoma. Its diagnosis must be made in a timely manner to allow for effective intervention and avoid life-threatening maternal and fetal complications. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: La distocia de hombros es una emergencia obstétrica no prevenible que causa graves complicaciones, como la parálisis braquial obstétrica. El objetivo del estudio fue determinar la incidencia de parálisis braquial obstétrica y de otras complicaciones neonatales asociadas a la distocia de hombros en los partos atendidos en un Hospital Universitario tras la implantación de un curso basado en simulación, de carácter voluntario y destinado a todos los profesionales en paritorio. Material y métodos: Estudio observacional retrospectivo; registro de los casos de distocia de hombros y de las complicaciones asociadas (principalmente parálisis braquial obstétrica) que tuvieron lugar entre enero del 2017 y diciembre del 2020, tras la implantación del curso. De forma paralela, se rescataron los casos de parálisis braquial obstétrica que tuvieron lugar en el hospital antes del entrenamiento (2008-2016). Resultados: En el período 2017-2020, de entre 125 distocias de hombros (lo que representa el 1,38% de los partos vaginales), hubo 14 casos de parálisis braquial obstétrica (el 11,2% de las distocias de hombros), siete fracturas de clavícula y una fractura de húmero; ninguna de las parálisis braquiales obstétricas fue permanente ni requirió tratamiento o rehabilitación más allá de los seis meses. En los años anteriores al entrenamiento, hubo siete casos de parálisis braquial obstétrica, dos permanentes y cinco transitorias (tres de las cuales necesitaron rehabilitación). Conclusión: Estos resultados reflejan la importancia de conocer la morbilidad presente en el paritorio y el posible beneficio de la formación basada en simulación para la resolución de estas complicaciones obstétricas. Abstract: Introduction: Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis. Material and methods: Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008–2016). Results: In 2017–2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation). Conclusion: These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications.

To describe and explore the risk factors, clinical presentations, timely diagnostic approaches, and management in patients experiencing unscarred uterine rupture with catastrophic hemorrhage. We retrospectively analyzed clinical and imaging data from women who encountered postpartum hemorrhage (PPH) and were diagnosed with unscarred uterine rupture within a three-year timeframe (2018-2020). The data were extracted from medical records obtained from a multi-hospital 24-hour emergency PPH transfer system. Six patients were identified as having unscarred uterine rupture after vaginal delivery. All six women were para 2, with four of them undergoing vacuum-assisted delivery. One patient experienced out-of-hospital cardiac arrest (OHCA), while five patients presented with hypovolemic shock. Abdominopelvic ultrasound revealed a boggy lower uterine segment. Initially, five patients underwent transarterial embolization (TAE) of the internal iliac arteries in an attempt to achieve hemostasis, but this approach proved unsuccessful. Abdominopelvic computed tomography (CT) confirmed the diagnosis of ruptured uterus by demonstrating disrupted myometrium and hemoperitoneum. Immediate exploratory laparotomy followed by life-saving hysterectomy was performed in all cases. The median estimated total blood loss was 2725 mL ± 900 mL (ranging from 1600 mL to 7100 mL). Lower segment lacerations were observed in all patients, with more extensive uterine damage noted in those who underwent vacuum extraction. The length of hospital stay varied between 9 and 38 days. Instrument-assisted obstetric delivery is a possible contributing factor to unscarred uterine rupture in our study. In specific cases, the use of abdominopelvic CT prior to initiating transarterial embolization (TAE) offers valuable information to complement ultrasound findings. This comprehensive approach helps in accurately identifying the underlying cause of intractable postpartum hemorrhage (PPH). Immediate conversion to laparotomy is essential to explore the intra-abdominal factors causing PPH that cannot be controlled by TAE. The rational etiologies of uterine rupture must be clarified while generating practical guideline in the future. [ABSTRACT FROM AUTHOR]

During the lockdown due to COVID-19 pandemic, utilization of emergency care units has been reported to be reduced for obstetrical and gynaecological reasons. The aim of this systematic review is to assess if this phenomenon reduced the rate of hospitalizations for any reason and to evaluate the main reasons for seeking care in this subset of the population. The search was conducted using the main electronic databases from January 2020 to May 2021. The studies were identified with the use of a combination of: "emergency department" OR "A&E" OR "emergency service" OR "emergency unit" OR "maternity service" AND "COVID-19" OR "COVID-19 pandemic" OR "SARS-COV-2" and "admission" OR "hospitalization". All the studies that evaluated women going to obstetrics & gynecology emergency department (ED) during the COVID-19 pandemic for any reason were included. The pooled proportion (PP) of hospitalizations increased from 22.7 to 30.6% during the lockdown periods, in particular from 48.0 to 53.9% for delivery. The PP of pregnant women suffering from hypertensive disorders increased (2.6 vs 1.2%), as well as women having contractions (52 vs 43%) and rupture of membranes (12.0 vs 9.1%). Oppositely, the PP of women having pelvic pain (12.4 vs 14.4%), suspected ectopic pregnancy (1.8 vs 2.0), reduced fetal movements (3.0 vs 3.3%), vaginal bleeding both for obstetrical (11.7 vs 12.8%) and gynecological issues (7.4 vs 9.2%) slightly reduced. During the lockdown, an increase in the proportion of hospitalizations for obstetrical and gynecological reasons has been registered, especially for labor symptoms and hypertensive disorders. [ABSTRACT FROM AUTHOR]

The number of Cesarean sections (CS) is growing worldwide, intensifying the risk of complications in subsequent pregnancies and leading to increased maternal and fetal morbidity and mortality. In particular, the literature shows a higher risk of uterine rupture (UR) in subsequent pregnancy with trial of labor after cesarean section (TOLAC) Furthermore, there are few data about pre-labor UR in scarred uteri. Since the key factor for management is timing, the aim of this study was to evaluate the accuracy of prenatal ultrasound (US) of scars in the early determining of pre-labor UR risk in women with a previous CS during their subsequent pregnancy From April 2014 to November 2018 a retrospective analysis was performed in order to evaluate the scar to vesicovaginal fold (VVF) distance in three patients with pre-labor UR and in 60 cases of the control group. The periconceptional CS scar-VVF distance in the three UR cases resulted significantly increased compared to the controls (23.7 ± 3.5 mm vs 2.3 ± 2.7 mm, p < 005); moreover, a time interval of less than 18 months and a previous pre-labor preterm CS were found as known risk factors. In this study, a higher uterine incision due to placenta previa or isthmic myoma seems to be correlated with a major risk of UR. Therefore, periconceptional US examination of CS-VVF distance, (which represents the level of the previous CS), seems to be a useful predictive factor of pre-labor UR in subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS), also known as "morbidly adherent placenta", represents a pathological entity that includes different types of abnormal placental implantation. The worldwide incidence of PAS is increasing rapidly, with the rise in the number of caesarean sections performed. More than 90% of PAS cases occur in women with at least one previous caesarean delivery. This pathological condition is associated with a high rate of maternal morbidity and mortality, presenting a unique challenge for its diagnosis and management. The major symptom is represented by antepartum vaginal bleeding. The diagnosis of PAS is made by imaging methods such as transabdominal or transvaginal ultrasound and magnetic resonance imaging. From the point of view of management, the timely confirmation of the diagnosis is vital to plan the delivery and to avoid a major life-threatening postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Background: The access of pregnant women to an appropriate health facility plays a crucial role in preventing maternal deaths. In the last decade, many new steps have been taken in the direction of making motherhood safe, one of them being the availability of free Emergency Medical Response Services (EMRS). In the present investigation, various variables were analyzed of the EMRS which provides services to pregnant women of the tribal district of Western India.Methods: This study is a descriptive analysis of EMRS provided to pregnant women from January 1, 2013 through December 31, 2020. The number of expected pregnancies was obtained from the state data center and the variables related to the benefitted pregnant women were generated with the EMRS tracking software.Results: The results of this study showed that 93.59% of pregnant women benefitted from these services in the last six years as compared to the estimated number of pregnancies. Whereas in the case of obstetric emergencies, 85.02% of pregnant women benefitted. Most of the beneficiaries were tribal, in the age group of 20-35 years, with lower socio-economic strata. More than 98.0% of pregnant women decided to take the delivery facility in the public hospitals. Across the district, ambulances had to travel less than 10km to cater to 89.0% of pregnant women.Conclusion: The convenient access of EMRS to pregnant women can improve the indicators of maternal and child health and reduce the risk of maternal death and home delivery. [ABSTRACT FROM AUTHOR]

Introduction: Severe hypertension in pregnancy deserves prompt recognition and urgent effective reduction in order to reduce the risk of complications such as eclampsia and HELLP syndrome and to achieve desirable neonatal outcomes. There is a need for effective and safe parenteral antihypertensive treatment., Subjects and Methods: We studied the effectiveness and safety of intravenous labetalol use in severe hypertension in pregnancy and post-partum period in a teaching hospital in Chhattisgarh in 101 women. IV labetalol was given as bolus doses till the blood pressures were controlled. Neonatal outcomes were recorded, and adverse effects such as hypotension, hypoglycemia, and neonatal asphyxia were documented., Results: Intravenous labetalol given as a single bolus of 20 mg was efficacious in controlling blood pressures in 93 out of 101 (93%) women, and the rest were controlled with 1 or 2 additional doses in 1-3 hours. No neonatal deaths happened beyond the 13 intrauterine fetal deaths at presentation. No women developed any episodes of hypotension, tachycardia of more than 100, or nausea or vomiting on labetalol., Conclusion: Intravenous labetalol, even as a single bolus dose, is highly efficacious and is free of any major adverse effects., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Background: Intestinal obstruction is an extremely rare condition among pregnant women, but it can be life-threatening for both mother and fetus. Case presentation: A woman in her late twenties with no history of previous pregnancies was admitted to hospital due to regular preterm contractions and cervical shortening. Seven days after her admission, while the contractions had stopped and cervical length was stable, she complained of acute abdominal pain. Bowel obstruction was suspected due to the patient's history of gastric bypass 5 years earlier for weight loss. Computed tomography was not performed due to risk of fetal irradiation. Conservative management was attempted, but the patient stopped passing flatus and started vomiting. The fetus was delivered by emergency exploratory laparotomy, during which small bowel obstruction due to adhesions was identified and resolved. Conclusion: Although uncommon during pregnancy, small bowel obstruction is far more common in women who have had previous abdominal operations, especially involving the stomach. Obstetricians must maintain a high level of suspicion since this condition can be life-threatening for both the mother and the fetus.

Objective: To validate the use of placenta accreta risk--antepartum (PAR-A) score as a predictive tool of clinical outcomes of placenta accreta spectrum (PAS). Methods: This is a prospective study, conducted in six PAS specialized centers in six different countries. The study was conducted between October 1, 2020 and March 31, 2021. Women who were provisionally diagnosed with PAS during pregnancy were considered eligible. A machine-learning-based PAR-A score was calculated. Diagnostic performance of the PAR-A score was evaluated using a receiver operating characteristic curve, for perioperative massive blood loss and admission to intensive care unit (ClinicalTrials.gov identifier NCT04525001). Results: Of 97 eligible women, 86 were included. PAS-associated massive blood loss occurred in 10 patients (11.63%). Median PAR-A scores of massive blood loss in the current cohort were 8.9 (interquartile range 6.9-14.1). In predicting massive blood loss, the area under the curve of PAR-A scores was 0.85 (95% confidence interval [CI] 0.74-0.95), which was not significantly different from the original cohort (P = 0.2). PAR-A score prediction of intensive care unit admission was slightly higher compared with the original cohort (0.88, 95% CI 0.81-0.95; P = 0.06). [ABSTRACT FROM AUTHOR]

Objectives. Postpartum haemorrhage is one of several direct causes of maternal death in Côte d’Ivoire. It is recurrent in the department of gynaecology and obstetrics at Bouaké University Hospital (CHU de Bouaké), but little is known to date about the underlying risk factors. The present study aims to describe the levels and trends displayed by the risk factors of postpartum haemorrhage before determining the contributing social factors in the aforesaid department. Material and methods. This study is retrospective in nature, concerning the period from 2014 to 2016. Data was obtained from delivery records and through individual interviews. The overall approach adopted is an anthropological one. Results. Postpartum haemorrhage is significant in light of its very high and increasing incidence (22.31%) among multiparous mothers. Within the latter category, fatal complications are a critical problem, with an annual average estimated at 35.98% and on the rise. The overall situation is alarming in view of this progressive deterioration. The persistence of the reproductive morbidity is attributable to various economic, social, cultural, and infrastructural factors. Conclusions. Communicational strategies are proposed as a type of community intervention conducive to social and behavioural change, with multiparous mothers as a priority target group, followed by older mothers in the medium term and by adolescent mothers in the long term. This should raise awareness about high-risk reproductive behaviours and practices as well as the environmental, economic, social, cultural, and infrastructural factors correlated to postpartum haemorrhage, with the ultimate goal of improving the quality and safety of reproductive practices.

Aims: The coronavirus 2019 infection (COVID-19) global outbreak has resulted in unprecedented pressures on health services, the need to prepare for the worst-case scenario, and the need for health experts to utilize their knowledge and expertise to fight this virus. The simulation training objective of this study was to enhance the neonatal, maternity, and anesthetics teams' preparedness for the management of the emergency delivery of pregnant women with suspected or confirmed COVID-19 infection.Methods: Three clinical simulation training sessions were conducted in March 2020 at the University Hospital Plymouth, Plymouth, UK. The neonatal, maternity, and anesthetics clinical teams participated in these joint training sessions in the obstetric emergency theater.Results: Each session lasted for around an hour. Suggestions were discussed and recommendations made. The key changes were: first, floor plan adjustment, increase of the clinical area by converting some offices to clinical spaces, and standard operating procedures for transporting patients; second, enhancement of the efficiency of the communication and coordination between the clinical teams; third, availability of extra support for the staff in the Central Delivery Suite (CDS); and fourth, introduction of a neonatal care pathway to manage neonatal resuscitation in such an emergency.Conclusions: Collaboration and joint training between the different clinical teams involved in the care of suspected or confirmed COVID-19 patients was proven to be one of the most effective ways of improving performance. [ABSTRACT FROM AUTHOR]

Background: Complete uterine rupture can lead to serious adverse maternal and child outcomes. Uterine rupture is rare, and it can occur in an intact uterus. Methods: We identified patients with intact uterus who encountered uterine rupture between 2010 and 2020 from the medical records of 10 hospitals in Sichuan Province. Results: In total, 37 cases of uterine rupture in intact uteri were identified. Eight ruptures (8/37, 21.6%) occurred before spontaneous labor, 11 ruptures (11/37, 29.7%) occurred during spontaneous labor, and 18 ruptures (18/37, 48.6%) occurred during induced labor. The clinical manifestations of the patients were abdominal pain in 20 cases (20/37, 54.1%), vaginal bleeding in three cases (3/37, 8.1%), and abdominal pain and vaginal bleeding in eight cases (8/37, 21.6%). The rate of hysterectomy/death was significantly higher in patients with more than three previous vaginal deliveries (p = 0.005). In addition, the rate of hysterectomy/death in the spontaneous labor group was significantly higher than that in the induced labor group (p = 0.011). The fetal survival rate in patients with uterine rupture at the uterine horn was significantly higher than that in patients with uterine rupture at the lower uterine segment (p = 0.007). Conclusions: Uterine rupture in an intact uterus was associated with a high hysterectomy rate and high fetal/neonatal mortality rate. For pregnant women with sudden abdominal pain and abnormal fetal heart rate, we should be alert to the possibility of uterine rupture. Induction and augmentation of labor need to be performed with caution to avoid this potential obstetric emergency.

Introduction: Postpartum hemorrhage (PPH) has remained the leading cause of maternal mortality. While anemia is a leading contributor to maternal morbidity, molecular, cellular and anemia‐induced hypoxia, clinical studies of the relationship between prenatal‐anemia and PPH have reported conflicting results. Therefore, our objective was to investigate the outcomes of studies on the relationships between prenatal anemia and PPH‐related mortality. Materials and Methods: Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, and the Cochrane Central Register of Controlled Trials) were searched for studies published before August 2019. Keywords included "anemia," "hemoglobin," "postpartum hemorrhage," and "postpartum bleeding." Only studies involving the association between anemia and PPH were included in the meta‐analysis. Our primary analysis used random effects models to synthesize odds‐ratios (ORs) extracted from the studies. Heterogeneity was formally assessed with the Higgins' I2 statistics, and explored using meta‐regression and subgroup analysis. Results: We found 13 eligible studies investigating the relationship between prenatal anemia and PPH. Our findings suggest that severe prenatal anemia increases PPH risk (OR = 3.54; 95% CI: 1.20, 10.4, p‐value = 0.020). There was no statistical association with mild (OR = 0.60; 95% CI: 0.31, 1.17, p‐value = 0.130), or moderate anemia (OR = 2.09; 95% CI: 0.40, 11.1, p‐value = 0.390) and the risk of PPH. Conclusion: Severe prenatal anemia is an important predictive factor of adverse outcomes, warranting intensive management during pregnancy. PROSPERO Registration Number: CRD42020149184; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=149184. [ABSTRACT FROM AUTHOR]

To explore healthcare workers' and women's experiences of providing and seeking childbirth care in a busy urban maternity facility in Tanzania. A qualitative study with observations, in-depth interviews, and informal conversations, using thematic network analysis. This study was conducted in a busy urban maternity unit in Dar es Salaam, Tanzania which is a low-resource setting with a need to improve childbirth care. Six frontline healthcare providers and four hospital managers from the facility, along with six postpartum women who gave birth at the facility. Delays were observed throughout the childbirth care cascade, encompassing various stages. During antenatal care, timely provision of care was hindered by a high patientto-provider ratio, resulting in inadequate monitoring of risk factors. At the onset of labor, women delayed seeking care, sometimes, attempting a trial of labor after a previous Caesarean section. Within the facility, delays in care decision-making and patient management were evident due to insufficient resources. The accumulation of these delays over time influenced the quality of care provided and challenged the management of obstetric emergencies at the study facility. The study findings show that delays are prevalent throughout the entire childbirth care cascade. The accumulation of these delays over time has influenced the quality of care provided at the facility and increased the vulnerability of women experiencing obstetric emergencies. To effectively address the imperative of reducing maternal mortality in low-resource settings, it is essential to develop appropriate interventions that span the entire spectrum of childbirth care. Additionally, further research is needed to delve into the complexities of care decision-making and the quality of care delivered within urban maternal facilities. Our findings stress the need for comprehensive childbirth interventions and contextspecific guidelines to address challenges across the care cascade, particularly in lowresource settings. Urgent attention is required to prioritize care during patient triage and address systemic challenges within the healthcare system to improve birth outcomes and ensure effective facility-based care provision. Trial registration number: NCT04685668 Date of initial trial registration: December 28th, 2020 [ABSTRACT FROM AUTHOR]

Synopsis: A rare case of a massive hemorrhage from a ruptured splenic artery aneurysm (SAA) in pregnancy that resulted in an emergency laparotomy, splenectomy, and cesarean section with maternal survival, but fetal loss, is presented. The development of protocols or guidelines for the early identification or prevention of SAA rupture in pregnancy would be of greater importance than reactive measures to control acute SAA bleeds. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypoxic–ischemic encephalopathy (HIE) in term infants, is a major cause of neonatal mortality and severe neurologic disability. Objectives: To identify in labor fetal monitoring characteristic patterns and perinatal factors associated with neonatal HIE. Study design: Single-center retrospective case–control study between 2010 and 2017. Cases clinically diagnosed with neonatal HIE treated by therapeutic hypothermia according to strict criteria (HIE-TH) were compared to a group of neonates born in the same period, gestational age-matched diagnosed with fetal distress according to fetal monitoring interpretation that was followed by prompt delivery, without subsequent HIE or therapeutic hypothermia (No-HIE). The primary outcome of the study was the electronic fetal monitoring (EFM) pattern during 60 min prior to delivery; the secondary outcome was the identification of perinatal associated factors. Results: 54 neonates with HIE were treated by therapeutic hypothermia. EFM parameters most predictive of HIE-TH were indeterminate baseline heart rate OR = 47.297, 95% (8.17–273.76) p < 0.001, bradycardia OR = 15.997 95% (4.18–61.18) p < 0.001, low variability OR = 10.224, 95% (2.71–38.45) p < 0.001, higher baseline of the fetal heart rate calculated for each increment of 1 BPM OR = 1.0547, 95% (1.001–1.116) p = 0.047. Rupture of a previous uterine cesarean scar and placental abruption were characteristic of the HIE-TH group 14.8% vs. 1% p < 0.05; and 16.7% vs. 6% p < 0.05, respectively. Adverse neonatal outcomes also differed significantly: HIE-TH had a higher rate of neonatal seizures 46.2% vs. 0% p < 0.001 and mortality 7.7% vs. 0% p < 0.001. Conclusions: Characteristic fetal monitoring pattern prior to delivery together with acute obstetric emergency events are associated with neonatal HIE, neurological morbidity, and mortality. [ABSTRACT FROM AUTHOR]

This review underscores the crucial role of interdisciplinary collaboration in managing obstetric emergencies such as crisis bleeding. Prompt clinical judgment and coordinated interventions involving various departments are emphasized for the well-being of both the mother and newborn. The review explores the importance of emergency response infrastructure in obstetric facilities and delves into the 2022 Obstetric Crisis Bleeding Guidelines, emphasizing the relevance of a DIC score for severity assessment. The collaborative efforts within the operating room, involving different healthcare professionals, are detailed, stressing meticulous coordination during emergencies like massive bleeding. The necessity of interprofessional collaboration for building a responsive perioperative management team is discussed, with a focus on leadership, followership, and effective communication. The abstract also proposes simulation-based education for inter-departmental training, emphasizing a modified non-technical skill evaluation tool tailored to the unique characteristics of obstetric crisis management in the operating room. Continuous formative assessment of these factors is deemed essential for effective training in various obstetric emergency situations., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

At an overcrowded government multi-specialty hospital serving the most densely populated area of Metro Manila, inward referrals of women in a moribund state and high volumes of low-risk maternity cases added to significant overcrowding and quality challenges in the maternity wards, resulting in high rates of maternal and neonatal death and near-miss. This case study of the public-private Network of Care, Quirino Recognized Partners (QRP), describes a series of pragmatic steps taken to build and maintain the network, particularly: building trust through agreements with private and public birth centers within a ten-kilometer radius, rolling out antenatal use of a clinical and socio-economic risk scoring tool, reaching out to potential clients, and establishing clear communication channels and protocols for care. These actions, consistent with the schematic of an effective Network of Care, helped decongest the hospital, build rapport and teamwork among health providers, and improve maternal and neonatal outcomes throughout the network. The purpose of this descriptive case study was to explore how QRP was established to solve for particular contextual problems, especially congestion and poor maternal and neonatal health outcomes, with express attention to how actions taken related to the domains of Networks of Care. Data collected through semi-structured interviews with relevant health care and other workers, institutional documents, observations, and field notes were interpreted through the domains of Networks of Care and reported through rich description.

Waleed Ali Sayed Ahmed, Mostafa Ahmed Hamdy Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt Abstract: Umbilical cord prolapse (UCP) is an uncommon obstetric emergency that can have significant neonatal morbidity and/or mortality. It is diagnosed by seeing/palpating the prolapsed cord outside or within the vagina in addition to abnormal fetal heart rate patterns. Women at higher risk of UCP include multiparas with malpresentation. Other risk factors include polyhydramnios and multiple pregnancies. Iatrogenic UCP (up to 50% of cases) can occur in procedures such as amniotomy, fetal blood sampling, and insertion of a cervical ripening balloon. The perinatal outcome largely depends on the location where the prolapse occurred and the gestational age/birthweight of the fetus. When UCP is diagnosed, delivery should be expedited. Usually, cesarean section is the delivery mode of choice, but vaginal/instrumental delivery could be tried if deemed quicker, particularly in the second stage of labor. Diagnosis-to-delivery interval should ideally be less than 30 minutes; however, if it is expected to be lengthy, measures to relieve cord compression should be attempted. Manual elevation of the presenting part and Vago’s method (bladder filling) are the most commonly used maneuvers. Care should be given not to cause cord spasm with excessive manipulation. Simulation training has been shown to improve/maintain all aspects of management and documentation. Prompt diagnosis and interventions and the positive impact of neonatal management have significantly improved the neonatal outcome. Keywords: umbilical cord prolapse, neonatal outcome, obstetric emergency, simulation training

Abstract Background Teamwork during obstetric emergency ensures good outcomes for both the woman and her baby. Effective teams are characterised by mutual respect, support, and cooperation among team members. Methods This qualitative, interpretive, phenomenological analysis study was conducted on a purposive sample of five, fourth-year Bachelor of Nursing Science student midwives at the University of Fort Hare (UFH). In-depth semi-structured interviews were conducted. Data analysis applied the interpretative phenomenological analysis method. Results Superordinate theme demonstrated teamwork elicited four clustered themes namely delegation of duties, the importance of teamwork, team support, and confident team leader. The participants recognised that there should be a team leader who is capable of delegating duties to other team members in the management of an obstetric emergency, Participants were confident not only to assign duties but to be kept updated of the intervention. They expressed the need to work collaboratively as a team to achieve the desired goal of providing quality care to the woman. The participants maintained that the team must be supportive and be able to help in decision making during simulation of an obstetric emergency. A sense of mutual respect is echoed by some participants in the process of caring for the woman. Some participants were confident at being team leaders and could see themselves as leaders in the real-life clinical situation. Conclusion The participants acknowledge the importance of teamwork in resolving obstetric emergencies. The importance of delegating duties to other team members, providing updated progress report ensures better outcomes for the woman.

At an overcrowded government multi-specialty hospital serving the most densely populated area of Metro Manila, inward referrals of women in a moribund state and high volumes of low-risk maternity cases added to significant overcrowding and quality challenges in the maternity wards, resulting in high rates of maternal and neonatal death and near-miss. This case study of the public-private Network of Care, Quirino Recognized Partners (QRP), describes a series of pragmatic steps taken to build and maintain the network, particularly: building trust through agreements with private and public birth centers within a ten-kilometer radius, rolling out antenatal use of a clinical and socio-economic risk scoring tool, reaching out to potential clients, and establishing clear communication channels and protocols for care. These actions, consistent with the schematic of an effective Network of Care, helped decongest the hospital, build rapport and teamwork among health providers, and improve maternal and neonatal outcomes throughout the network. The purpose of this descriptive case study was to explore how QRP was established to solve for particular contextual problems, especially congestion and poor maternal and neonatal health outcomes, with express attention to how actions taken related to the domains of Networks of Care. Data collected through semi-structured interviews with relevant health care and other workers, institutional documents, observations, and field notes were interpreted through the domains of Networks of Care and reported through rich description. [ABSTRACT FROM AUTHOR]

The gestational period may follow emergency complications and may cause imminent death threat to maternal and/or fetal life, contributing to the increased mortality rate in this population. Facing the unexpected, in these cases, can provoke experiences in which the subject faces an unbearable moment, impossible to symbolize. In psychoanalysis, this moment can be attributed to the concept of subjective urgency. Given this, the present article seeks to discuss how women in high-risk obstetric emergencies may be affected by the experience of subjective urgency and the consequences of this meeting. We propose to understand the concept of subjective urgency in the light of psychoanalytic theory and to identify its intertwining with the high-risk obstetric emergency. This is theoretical research in psychoanalysis, qualitative and exploratory, conducted from a bibliographical selection. The analysis of the data found consisted of the identification and discussion of concepts that intertwine with subjective urgency, in an attempt to think about this connection in high-risk obstetric emergencies. The literature showed that subjective urgency is associated with a moment of crisis, indicating a rupture in the discursive dimension, exposing the subject to the overwhelming and disordered real, so that anguish, trauma and time were identified as some of the concepts intertwined with subjective urgency. Concerning high-risk obstetric emergencies, elements such as losses, unexpected events and disruptions may indicate the possibility of subjective urgency being inscribed. However, it was evidenced that, sometimes, these events are treated by the immediacy, making it impossible for the subject to redefine his experience. Thus, it is taken care that, in the face of the chaos established in these environments, a pause will be given to rescue the previously diluted discursive chain and the subject may reorganize it. [ABSTRACT FROM AUTHOR]

Objective: The World Maternal Antifibrinolytic (WOMAN) Trial was the first in the UK to use the option of waiver of informed consent at the time of an obstetric emergency. This qualitative study aimed to investigate participants' views of the acceptability of the recruitment methods used.Design: Qualitative study using in-depth interviews with women who did and did not give consent at the time of their recruitment to the WOMAN Trial.Setting: Highest UK recruitment site for the WOMAN Trial (129/569). Interviews were conducted in participants' homes.Population: About 40 of the 129 women who were recruited to the WOMAN Trial at one UK site were invited to take part, 15 women were interviewed.Methods: Qualitative, interview study.Main Outcome Measures: Facilitators and barriers to successful recruitment during obstetric emergencies. Guidance for future researchers.Results: Findings revealed that what is important is not so much the consent process used or a signature on a form, but the way in which consent is obtained. Clinicians who successfully negotiate consent to research during childbirth emergencies engage in a 'humane choreography' of words and actions. This emphasises the importance of prompt decision-making and treatment, while respecting the woman's personal situation and experience.Conclusions: Our findings do not support a single pathway to consent in the context of an obstetric emergency. Women understand that consent to research in an emergency is complex. Clinicians' skills in considering the clinical, ethical, and emotional aspects within the context of the clinical emergency can hamper or promote women's satisfaction.Tweetable Abstract: Study reports on women's views of consent to research in an obstetric emergency.Plain Language Summary: Why and how was the study carried out? We undertook this study to find out what women thought about being included in a research study called the WOMAN Trial at the time they were being treated for heavy bleeding after giving birth. Some women had been asked if they wanted to be a part of the research at the time they were bleeding. Others were asked later, after they had recovered. We conducted interviews with 15 women who had been involved and asked what they thought about the way they had been asked, their preferences and ideas for improvements in future similar studies What were the main findings? Women understood how difficult it was for their doctors and midwives to ask them about the research study. They were pleased to have been included in the research and were mostly happy with the way they gave consent. Women's views were similar whether they were asked about the research at the time of the bleeding or after they had recovered. The most important thing was that doctors and midwives carefully thought about the situation the woman found herself in and how this might make her feel, so they could tailor their approach accordingly. What are the limitations of the work? This study only involved women from one hospital. The WOMAN Trial included women from many areas of the UK and other countries around the world. We do not know how their experiences or views may differ. What is the implication for professionals? Careful use of actions and words by birth attendants was the difference between a good or bad experience for the woman and her family. This is an important skill that could be developed as part of professional training. [ABSTRACT FROM AUTHOR]

Abstract Objective Aim of this study was to introduce posterior axilla sling traction (PAST) in delivering providers and nursing staff as an adjunct to the management of shoulder dystocia and evaluate comfort in performing the maneuver. Methods A presimulation questionnaire had given to all participants. A brief training on how to perform PAST was also given. A simulated shoulder dystocia was run where usual maneuvers failed. Participants used PAST for delivery of posterior shoulder, delivery of posterior arm, and to assist with rotation. Participants were then given a post-simulation questionnaire. A Chi-squared test was used to evaluate comfort with performing the procedure pre and post-simulation. Results Data were collected from 43 participants at pre and post-simulation. Designations (attending, resident, midwife, registered nurse) and responses were recorded to the questionnaires. There was a statistically significant increase in the number of providers and nurses who would feel comfortable using PAST for shoulder dystocia management and for rotational maneuvers. Ninety-three percent of participants would consider using PAST in future shoulder dystocia when usual maneuvers failed. Conclusion PAST is an adjunct to management of shoulder dystocia that has not previously been taught in our facility. The majority of participants in our simulation felt comfortable with using PAST.

Umbilical cord prolapse (UCP) is an uncommon obstetric emergency that can have significant neonatal morbidity and/or mortality. It is diagnosed by seeing/palpating the prolapsed cord outside or within the vagina in addition to abnormal fetal heart rate patterns. Women at higher risk of UCP include multiparas with malpresentation. Other risk factors include polyhydramnios and multiple pregnancies. Iatrogenic UCP (up to 50% of cases) can occur in procedures such as amniotomy, fetal blood sampling, and insertion of a cervical ripening balloon. The perinatal outcome largely depends on the location where the prolapse occurred and the gestational age/birthweight of the fetus. When UCP is diagnosed, delivery should be expedited. Usually, cesarean section is the delivery mode of choice, but vaginal/instrumental delivery could be tried if deemed quicker, particularly in the second stage of labor. Diagnosis-to-delivery interval should ideally be less than 30 minutes; however, if it is expected to be lengthy, measures to relieve cord compression should be attempted. Manual elevation of the presenting part and Vago's method (bladder filling) are the most commonly used maneuvers. Care should be given not to cause cord spasm with excessive manipulation. Simulation training has been shown to improve/maintain all aspects of management and documentation. Prompt diagnosis and interventions and the positive impact of neonatal management have significantly improved the neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: To describe the adaptation of an obstetric emergencies training program to align with local clinical practice.Methods: A feasibility study was conducted to investigate the potential implementation of the PRactical Obstetric Multi-Professional Training (PROMPT) program at eight urban tertiary hospitals in the Philippines. Multi-professional teams attended a 2-day course on September 23 and 24, 2015, that comprised a demonstration PROMPT course (day 1) and a Train-the-Trainers session (day 2). During a facilitated adaptation session, each team reviewed the PROMPT algorithms for eclampsia, severe pre-eclampsia, postpartum hemorrhage and sepsis. The teams marked steps concordant with local practice and identified differences with local practice. Suggested amendments were reviewed by the PROMPT project team, using clinical guidelines to support any adaptations.Results: The PROMPT algorithm for initial management of eclampsia was used as an exemplar. Five of the nine management steps were concordant with local practice: support; airway; breathing; circulation; and control seizures. Amendments were successfully implemented for the following steps: call for help; magnesium sulfate loading dose; and magnesium sulfate maintenance dose.Conclusion: Rapid and efficient adaptation of PROMPT training materials for use in the Philippines was possible using a facilitated and focused approach, utilizing the expertise of a representative mix of local healthcare professionals and evidence-based guidelines. [ABSTRACT FROM AUTHOR]

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